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SOUTH AFRICA: Three-Letter Plague

Photo: Jonathan Ball Publishers
Johannesburg, 1 July 2008 (PlusNews) - Everyone knows the story of how HIV/AIDS treatment finally became available to ordinary South Africans. It is a tale of science and reason pitted against denial and superstition, of a long struggle in which AIDS activists eventually prevailed over politicians.

By now, the life-prolonging effects of antiretroviral (ARV) treatment have become a familiar and comforting antidote to the years of helplessly watching people succumb to the virus. With the right of poor Africans to ARV treatment firmly established, and their ability to adhere to a lifelong drug regimen well demonstrated, the new struggle is to ensure that every HIV-positive African in need of treatment receives it.

If only we had more doctors and nurses, we are told; if only we had better health systems and the necessary political will, we could achieve the goal of universal access to treatment.

In his book, Three-Letter Plague, South African author and journalist Jonny Steinberg examines the implicit premise behind this goal: that if good treatment is available, people will come and get it.

Refusing to be swept along by the missionary-like zeal of treatment lobby groups like South Africa's Treatment Action Campaign and international medical aid organisation, Médecins Sans Frontières (MSF), Steinberg attempts to answer the thorny question of why so many South Africans choose not to test for HIV or to take ARVs, despite the availability of good treatment.

He goes looking for answers in the rural Eastern Cape district of Lusikisiki, where MSF pioneered the use of under-resourced and under-utilised primary health-care clinics to deliver ARV treatment to thousands of local people.In a place where ARVs are available at local clinics instead of distant hospitals, and a well-trained army of lay counsellors support nurses in distributing them, he still finds people with AIDS-related illnesses who choose to stay home and die.

Dr Hermann Reuter, a central character in Steinberg's narrative who ran MSF's Lusikisiki programme until it was handed over to local authorities in 2006, offers one explanation: if an individual has travelled a long distance to reach a health facility, and then has to wait hours to see a nurse, who turns him away or gives him inferior care, he is not likely to return.

Without government investment and buy-in, the MSF programme could only achieve so much. Reuter maintains that if local clinics were provided with electricity and running water, stocked with drugs and equipment, and staffed by well-paid health professionals, the patients would come.

Suspecting that Reuter's explanation tells only part of a much more complex story, Steinberg enlists Sizwe Magadla, 29, a local man, to help him delve deeper.

A successful spaza [informal] shop owner, Magadla is well-educated and affluent by the standards of his remote, impoverished village. He knows about the dangers of HIV; like most South Africans, he has watched people close to him sicken and die from it. He also knows there is a significant chance that he himself may be HIV-positive; yet he refuses to be tested.

"This is not a disease you go and look for," he tells Steinberg. "You wait until it comes to you, and then you deal with it."

During the 18 months Steinberg spends regularly visiting Magadla and employing him as a translator, the reasons the young man gives for not testing are as contradictory and complex as the world he lives in.

In Magadla's eyes, the local people on ARV treatment, who are walking evidence that the "magic pills" work, are at odds with his deep suspicion of white men and their medicine.

He knows that HIV is transmitted through unprotected sex, but also believes in the power of evil spirits. He buys a herbal "cure" for his HIV-positive cousin, yet also takes her and her boyfriend to the clinic.

In Magadla’s world, the shame and fear of HIV are as great a threat as the virus itself: "If I know that I am positive, I will die quicker ... Knowing that my blood is dirty, feeling it every time I wake up in the morning, it would not be long before I'm dead," he says.

In Three-Letter Plague, Steinberg raises more questions about South Africa's AIDS crisis and what it means for the country than he can answer, but he suggests it is an enigma that Western science alone cannot solve. People, in all their complexity, lie at the heart of the pandemic, and it is their hopes and fears, beliefs and motivations that must be understood before goals like universal access can be achieved.

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Theme (s): Arts/Culture - PlusNews, Care/Treatment - PlusNews, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

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